Recent trends in the advancement of surgical technology have tended toward less and less invasive procedures in order to reduce morbidity and mortality of the surgical procedures, thereby increasing the benefit to the patient.
An important advancement in the area of cardiac surgery is represented by co-owned, copending patent applications, Ser. Nos. 08/281,981 and 08/281,962, which describe, in detail, endoaortic catheter devices and systems for inducing cardioplegic arrest in the heart of a patient and for carrying out surgical procedures, such as coronary artery bypass graft (CABG) surgery or heart valve replacement surgery, on the arrested heart. One surgical approach presented in the parent applications is known as closed-chest or port-access cardiac surgery, in which access is gained to the exterior of the heart through percutaneous intercostal penetrations in the wall of the patient's chest. In port-access cardiac surgery the surgical procedure is carried out using instruments that operate through the intercostal penetrations while the heart is stopped using the endoaortic catheter. Another surgical approach presented in the parent applications is an endovascular approach, in which diagnostic or therapeutic endovascular devices are inserted through a lumen in the endoaortic catheter to carry out an endovascular procedure within the heart or blood vessels of the patient. The present invention addresses the endovascular surgical approach and the endovascular procedures that can be carried out using the endoaortic catheter.
It has been suggested previously to combine certain endovascular procedures as an adjunct to cardiac surgery procedures, such as combining intraoperative coronary balloon angioplasty with conventional coronary artery bypass grafting in order to achieve more complete revascularization of the patient's coronary arteries. To date there has only been very limited clinical acceptance of this combined procedure. One reason for this limited acceptance may be that the standard aortic crossclamps used for isolating the heart from the remainder of the arterial system during CABG surgery occlude the aortic lumen, preventing the angioplasty catheter from being introduced into the coronary arteries by the usual transluminal approach.
The present invention provides a system including devices and methods that combine a means for occluding the aortic lumen to isolate the heart from the remainder of the arterial system with a means for introducing an endovascular device into the heart or the blood vessels of the heart. This combination provides a number of advantages not contemplated by the prior art. Namely, the invention allows the combination of diagnostic and therapeutic endovascular procedures with cardiopulmonary bypass and cardioplegic arrest in a manner that facilitates rather than inhibits the performance of both procedures. That is to say that the isolation of the heart and its blood vessels necessary for cardioplegia and cardiopulmonary support can be accomplished entirely through endovascular means without the necessity of a gross thoracotomy, and that, simultaneously, a path is created for introduction for one or more devices for performing a diagnostic or therapeutic endovascular procedure.
Endovascular procedures which lend themselves to this approach include diagnostic procedures, such as visualization of internal cardiac or vascular structures by optical or ultrasonic means or electrophysiological mapping of the heart, and therapeutic procedures, such as valvuloplasty, angioplasty, atherectomy, thrombectomy, stent placement, laser angioplasty, transmyocardial revascularization, or ablation of electrophysiological structures within the heart.